Virtusa and Amazon Web Services (AWS) recently co-presented a webinar on genAI and its transformative role in the healthcare ecosystem.

The session featured an expert panel including:

Alok Mandal- Head of Consulting Practice for Healthcare and Life Sciences at Virtusa
Arun Velliangiri- Senior Solution Architect with AWS
Ryan Sonfist- Head of Healthcare Providers at AWS
Becca Bui- Head of Healthcare Payer at AWS
Moderator: Amit Ghoshal, Virtusa.

GenAI and the impending crossroads in the healthcare ecosystem

The healthcare ecosystem is at an impending crossroads today: one path leads toward groundbreaking innovations, and the other toward ongoing crises marked by rising costs, workforce burnout, and inequities in access.

As healthcare continues to evolve, new possibilities powered by generative AI are emerging as scalable, proven tools already reshaping operations, compliance, and patient engagement.

A clear, responsible path forward is a perfect balance of innovation and consistent care. In a recent panel hosted by Virtusa and AWS, healthcare leaders explored what that path might look like and what it will take to move from experimentation to enterprise-scale impact.

Dilemma: To innovate or to stabilize the healthcare ecosystem

Healthcare executives are navigating conflicting pressures: reduce operational cost, comply with evolving regulations, close equity gaps, and still deliver high-quality care. For many, the dilemma of staying relevant without losing control outpowers innovation strategies.

Cost pressure is rising across the value chain, from payers balancing risk and reimbursement to providers absorbing administrative load with limited staff. Meanwhile, member expectations are shifting. Patients now expect personalized, seamless, and responsive service across both digital and clinical touchpoints.

GenAI presents an opportunity to shift away from reactionary, manual, and fragmented systems toward real-time insight, automation, and intelligent workflows. But success depends on asking the right questions up front: What should be automated? Where do humans add unique value? And how do we build responsibly from the inside out?

Solving what slows healthcare down

Across the healthcare industry, administrative processes like provider onboarding, claims reviews, and prior authorization continue to consume time and resources. At the same time, CMS mandates around data interoperability and prior authorization reform require new levels of transparency and speed. Delays in documentation, lack of data standardization, and fragmented legacy systems are holding healthcare back from its digital potential.

GenAI tools are already proving effective in:

Automating document processing and summarization
Accelerating decision-making through real-time data extraction
Supporting compliance with explainable, auditable AI models

The benefit goes beyond cost savings. Faster onboarding can reduce provider churn. Streamlined claims handling can lift satisfaction scores. Intelligent automation allows teams to focus on judgment and not paperwork. These use cases aren’t pilots. These solutions are operational today, delivering real results in production.

Aligning genAI with health equity goals

Disparities in access, outcomes, and experience continue to be a core focus for regulators, payers, and providers alike. From rural connectivity to language access to racial bias in clinical decision-making, health equity remains one of healthcare’s most entrenched and urgent challenges.

GenAI can support more equitable care by incorporating social determinants of health into workflows and enabling personalized engagement across communities. This requires collaboration between clinical teams, data architects, and technology leaders to ensure AI doesn't replicate existing biases, but actively works to correct them.

“At Virtusa, we strongly believe that success with innovation and especially things as powerful as GenAI should start with a focus and clarity. "- Alok Mandal.

Laying the groundwork: Data and workflow readiness

Data interoperability

For genAI to function effectively, clean, connected, and context-aware data is essential. Investing in data interoperability and modernizing the legacy system is key. Breaking down silos across clinical, operational, and financial systems is critical to building intelligent, unbiased models.

Workflow integration

Standardizing existing workflows improves day-to-day operations and can remove complexities. GenAI plays a critical role in reducing these gaps. Aligning technology with social determinants can help healthcare professionals and enhance the overall healthcare payer experience.

Responsible AI: Building trust and governance

In healthcare, outcomes carry weight. That’s why every genAI model must be governed across validation, accountability, and explainability. Responsible AI is the foundation for scaling trustworthy, compliant, and ethical automation in patient-facing and back-office systems.

This includes:

Traceability of model training data and logic
Ongoing validation and drift detection
Role-based access control and audit trails
Human-in-the-loop decision checkpoints for high-risk actions

In healthcare, the cost of getting it wrong is too high. Responsible AI ensures we get it right—and keep getting it right as systems evolve.

Success stories: Virtusa's genAI implementations

Provider lifecycle management (PLM)

Virtusa helped national and regional payers reduce provider onboarding time by 66% through end-to-end automation. The result: faster access to care, fewer administrative handoffs, and improved provider satisfaction.

Prior authorization automation

With GenAI and NLP, a major payer achieved 60% faster turnaround on authorizations and lifted provider satisfaction. Built using AWS Foundation models, the solution generated personalized, context-aware contract recommendations.

Claims summarization and abuse detection

For a leading insurer, Virtusa applied GenAI to automate clinical note reviews, cutting manual processing by 40%, reducing turnaround time by 60%, and achieving 100% onboarding transparency. This improved decision consistency and operational efficiency.

AI-assisted claims review

A national payer used Virtusa’s solution to analyze dental X-rays and medical images via AWS, integrating the insights into claims review workflows. The patented algorithm achieved an 85% claim propensity score, supporting reviewers with clear recommendations on whether to uphold or overturn disputed decisions.

The efforts were beyond experimental. They are scalable, operational, and compliant with existing healthcare mandates.

Innovation with transparency and integrity: A new era in healthcare

As short-term financial pressures mount, healthcare organizations can’t afford to stall innovation, nor can they rush adoption without oversight. The future belongs to those who take a balanced path: deploying Responsible AI with governance, building systems that scale, and aligning every change with better care outcomes.

Healthcare’s next chapter will be written by organizations that view genAI not as a tool to reduce headcount but as an enabler to elevate care, reduce fatigue, and deliver operational excellence at scale. Virtusa, together with AWS, continues to work with healthcare leaders to deliver this balance, transforming the administrative core while protecting what matters most: the human experience of care.

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